ASO Author Reflections: Preoperative Assessment of Remnant Liver Function
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Preoperative Assessment of Remnant Liver Function Yajie Wang, BE1, Lin Zhang, MD2,3, Jiahong Dong, MD2, and Huijun Chen, PhD1 1
Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China; 2Hepato-pancreato-biliary Center, Beijing Tsinghua Changgung Hospital, School of Medicine, Tsinghua University, Beijing, China; 3Department of Radiology, Southwest Hospital, Army Medical University, Chongqing, China
PAST
PRESENT
For patients with hepatocellular carcinoma (HCC) who need hepatectomy, preoperative assessment of remnant liver function is important for surgical planning and reducing the posthepatectomy liver failure (PHLF) rate. In current clinical practice, parameters that reflect the whole liver function (blood serum indices, Child–Pugh score, indocyanine green [ICG] retention rate) and the remnant liver volume or volume ratio were used to rule out highrisk patients.1,2 As none of these criteria can directly measure the inhomogeneous distribution of the liver function, which is common in patients with liver disease, the accuracy of these criteria are limited. Recently, methods based on single-photon emission computed tomography (SPECT)3 or dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with liverspecific contrast agent4 have been proposed to image the localized liver function; however, these new imaging techniques have poor clinical availability due to their radiation or specially designed imaging sequence.
Yajie Wang and Lin Zhang have contributed equally to this work.
In this study,5 116 patients with HCC who underwent liver resection in Southwest Hospital were retrospectively recruited. Accurate remnant liver function evaluation methods were proposed using a clinical routine Gd-EOBDTPA-enhanced MR imaging protocol by combining the remnant liver volume and regional liver function parameters generated from dynamic Gd-EOB-DTPA-enhanced MRI. The remnant liver function parameters measured using the proposed methods showed significant differences between patients with and without PHLF. Each of the proposed remnant liver function parameters was the independent significant indicator in predicting PHLF after adjusting for other PHLF risk factors, including sex, age, hepatitis, cirrhosis, portal hypertension, several preoperative blood indices, and intraoperative parameters. More importantly, receiver operating characteristic (ROC) analyses showed the proposed imaging-based remnant liver function parameters had larger area under the curves (AUCs) than the remnant liver volume/standard liver volume (RLV/SLV) and ICG-based parameters in predicting PHLF. This study demonstrated that the proposed remnant liver function parameters had the ability to predict PHLF in patients with HCC and may be better predictors than conventional methods.
Ó Society of Surgical Oncology 2020
FUTURE
First Received: 2 October 2020 Accepted: 3 October 2020 J. Dong, MD e-mail: [email protected]
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